Sepsis in Obstetric Care

For the purpose of this Bundle, sepsis in obstetric care refers to the World Health Organization definition for maternal sepsis as a life-threatening condition defined as organ dysfunction resulting from infection during pregnancy, childbirth, post-abortion, or the postpartum period (up to 42 days). Such conditions include infections that are related to delivery and other types of infections that occur during pregnancy or the postpartum period.

Readiness

Every Unit

Establish inter- and intradepartmental protocols and policies for the care of patients experiencing obstetric sepsis or suspected sepsis.*
Provide multidisciplinary education on obstetric sepsis to all clinicians and staff that provide care to pregnant and postpartum people, including in non-labor & delivery settings such as emergency departments, intensive care units, and outpatient clinics.*
Utilize evidence-based criteria for sepsis assessment for all pregnant and postpartum patients, in all units, including obstetric-specific criteria, when appropriate.*
Create a culture that utilizes non-hierarchical communication so that all team members, including the patient, feel empowered to speak up about a concern and know that their input is valued by the entire care team.*

*See Sepsis in Obstetrical Care Element Implementation Details (PDF)

Recognition & Prevention

Every Patient

Implement evidence-based measures to prevent infection.*
Recognize and treat infection early to prevent progression to sepsis.*
Consider sepsis on the differential diagnosis of a person with deteriorating status, even in the absence of fever.*
In all care environments, assess and document if a patient presenting is pregnant or has been pregnant within the past year.*
Provide patient education focused on general life-threatening pregnancy and postpartum complications and early warning signs, including sepsis signs and symptoms other than fever, and instructions for who to notify with concerns.*

Response

Every Event

Initiate facility-wide standard protocols and policies for assessment, treatment, and escalation of care for people with suspected or confirmed obstetric sepsis.*
Initiate facility-wide standard protocols and policies for post-stabilization management of people with sepsis.*
Engage in team communication among units involved in the care coordination for patients with sepsis to understand diagnoses, treatment plans, and follow-up care.*
Facilitate comprehensive post-sepsis care, including screening and proper referrals for post-sepsis syndrome.*

Reporting & Systems Learning

Every Unit

Conduct multidisciplinary reviews for systems improvement of each sepsis case to assess the screening program, the quality of care provided to patients with sepsis, and whether instances of bias may have impacted care.*
Establish a culture of multidisciplinary planning, huddles, and post-event debriefs.
Implement a system to ensure communication occurs with the pregnant or postpartum person and their identified support network on an ongoing basis during treatment and through follow-up care.*

Respectful, Equitable & Supportive Care

Every Unit/Provider/Team Member

Include each pregnant or postpartum person and their identified support network as respected members of and contributors to the multidisciplinary care team.*
Engage in open, transparent, and empathetic communication with pregnant and postpartum people and their identified support network about sepsis diagnosis and recommended treatment plans that are aligned with their health literacy, culture, language, and accessibility needs.*
Because maternal mortality and severe maternal morbidity related to sepsis disproportionately affect Black, Indigenous, and Hispanic people because of systemic racism, but not race itself, it is necessary to mitigate this bias by having a high index of suspicion for sepsis.*

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Patient Safety Bundle Acknowledgements

This Patient Safety Bundle was originally developed by the Alliance for Innovation on Maternal Health in collaboration with Catherine Albright, MD, MS; Melissa Bauer, DO*; Carol Burke, MSN; April Chavez, PLEC; Ronald Gibbs, MD*; R. Phillips Heine, MD; Brenna Hughes, MD; Maile LaBeouf, MS, PLEC; Elliott Main, MD; Tiffany Messerall, WHNP, RNC-OB; Luis Pacheco, MD; Malavika Prabhu, MD; Laura Riley, MD; Rachel Solnick, MD; Andrew Youmans, CNM, MSN.
The American Academy of Family Physicians, American College of Obstetricians and Gynecologists District II, Emergency Nurses Association, End Sepsis, Michigan AIM, Ohio Health, Sepsis Alliance, University of California Los Angeles, University of California San Francisco, Washington State Hospital Association, and Wayne State University reviewed and provided feedback on this document.

© 2022 American College of Obstetricians and Gynecologists. Permission is hereby granted for duplication and distribution of this document, in its entirety and without modification, for solely non-commercial activities that are for educational, quality improvement, and patient safety purposes. All other uses requite written permission from ACOG.
Standardization of health care processes and reduced variation has been shown to improve outcomes and quality of care. This bundle reflects emerging clinical, scientific, and patient safety advances as of the date issued and is subject to change. The information should not be construed as dictating an exclusive course of treatment or procedure to be followed. Although the components of a particular bundle may be adapted to local resources, standardization within an institution is strongly encouraged.